Combined Fractures of the Scaphoid and Distal Radius: Evaluation of Early Surgical Fixation (21 Patients with 22 Wrists)Funding None.
23 January 2017
17 April 2017
12 May 2017 (eFirst)
Introduction The purpose of this retrospective study, is to evaluate the clinical and functional results of early surgical fixation of the ipsilateral distal radius and scaphoid fractures in 22 of 21 patients.
Patients and Methods Overall, 22 combined ipsilateral scaphoid, and distal radius fracture treatments between 2002 and 2015 were evaluated. The mean age was 34.9 (range: 19–82) years. One patient had bilateral injuries. In 17 patients the injury was due to a fall from a height, and in 4 patients due to a motorcycle accident. According to the AO classification, there were 2 type B and 20 type C fractures of the distal radius. The volar locking plate fixation technique was applied in 14 wrists, screw fixation technique in 1, external fixation combined with Kirschner wires (K-wire) stabilization technique was used in 3 wrists, and only K-wire pinning technique was used in 4 wrists. All scaphoid fractures were type B (21 type B2, 1 type B1) according to the Herbert–Fischer classification. K-wire fixation was applied in 2 and cannulated screw fixation was performed in 20 fractures. Clinical evaluation was performed with measuring the pinch power, grip power, and range of motions. Functional evaluation was performed using patient-rated wrist evaluation score (PRWE).
Results The average follow-up period was 25 (range: 12–97) months. All radius and scaphoid fractures healed. The mean active wrist motions were found to be 45 degrees of flexion, 48.5 degrees of extension, 20 degrees of radial deviation, and 43 degrees ulnar deviation. Mean grip/pinch strengths were 31/8.5 kg. Mean PRWE score was 5.5 (range: 0–8.5). All patients returned to preoperative activity level and can do preinjury jobs.
Conclusion Combined ipsilateral fractures of distal radius and scaphoid are complex and rare injuries due to high energy traumas. Stable early primary fracture fixation in these injuries can be expected with good functional results.
Level of Evidence Level IV.
- 1 Hove LM. Simultaneous scaphoid and distal radial fractures. J Hand Surg [Br] 1994; 19 (03) 384-388
- 2 Komura S, Yokoi T, Nonomura H, Tanahashi H, Satake T, Watanabe N. Incidence and characteristics of carpal fractures occurring concurrently with distal radius fractures. J Hand Surg Am 2012; 37 (03) 469-476
- 3 Tountas AA, Waddell JP. Simultaneous fractures of the distal radius and scaphoid. J Orthop Trauma 1987; 1 (04) 312-317
- 4 Chang CH, Tsai YS, Sun JS, Hou SM. Ipsilateral distal radius and scaphoid fractures. J Formos Med Assoc 2000; 99 (09) 733-737
- 5 Richards RR, Ghose T, McBroom RJ. Ipsilateral fractures of the distal radius and scaphoid treated by Herbert screw and external skeletal fixation. A report of two cases. Clin Orthop Relat Res 1992; (282) 219-221
- 6 Slade III JF, Taksali S, Safanda J. Combined fractures of the scaphoid and distal radius: a revised treatment rationale using percutaneous and arthroscopic techniques. Hand Clin 2005; 21 (03) 427-441
- 7 Proubasta IR, Lluch AL. Concomitant fractures of the scaphoid and the distal end of the radius: treatment by external fixation. A report of two cases. J Bone Joint Surg Am 1991; 73 (06) 938-940
- 8 Rutgers M, Mudgal CS, Shin R. Combined fractures of the distal radius and scaphoid. J Hand Surg Eur Vol 2008; 33 (04) 478-483
- 9 Trumble TE, Benirschke SK, Vedder NB. Ipsilateral fractures of the scaphoid and radius. J Hand Surg Am 1993; 18 (01) 8-14
- 10 Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 1976; 58 (04) 453-458
- 11 Müller ME, Nazarian S, Koch P. Classification AO des fractures. Tome I. Les os longs (1st ed). Berlin: Springer-Verlag; 1987
- 12 Herbert TJ, Fisher WE. Management of the fractured scaphoid using a new bone screw. J Bone Joint Surg Br 1984; 66 (01) 114-123
- 13 Naranje S, Kotwal PP, Shamshery P, Gupta V, Nag HL. Percutaneous fixation of selected scaphoid fractures by dorsal approach. Int Orthop 2010; 34 (07) 997-1003
- 14 Sügün TS, Gürbüz Y, Ozaksar K, Toros T, Kayalar M, Bal E. Results of volar locking plating for unstable distal radius fractures. Acta Orthop Traumatol Turc 2012; 46 (01) 22-25
- 15 Figl M, Weninger P, Liska M, Hofbauer M, Leixnering M. Volar fixed-angle plate osteosynthesis of unstable distal radius fractures: 12 months results. Arch Orthop Trauma Surg 2009; 129 (05) 661-669
- 16 Kiliç A, Kabukçuoğlu Y, Ozkaya U, Gül M, Sökücü S, Ozdoğan U. Volar locking plate fixation of unstable distal radius fractures [in Turkish]. Acta Orthop Traumatol Turc 2009; 43 (04) 303-308
- 17 MacDermid JC. The Patient-Rated Tennis Elbow Evaluation (PRTEE) © user manual. J Hand Ther 2005; 18 (04) 407-410
- 18 Vukov V, Ristić K, Stevanović M, Bumbasirević M. Simultaneous fractures of the distal end of the radius and the scaphoid bone. J Orthop Trauma 1988; 2 (02) 120-123
- 19 Koval KJ, Harrast JJ, Anglen JO, Weinstein JN. Fractures of the distal part of the radius. The evolution of practice over time. Where's the evidence?. J Bone Joint Surg Am 2008; 90 (09) 1855-1861
- 20 Ozkan K, Ugutmen E, Unay K, Poyanli O, Guven M, Eren A. Fractures of the bilateral distal radius and scaphoid: a case report. J Med Case Reports 2008; 2: 93 . Doi: 10.1186/1752-1947-2-93
- 21 Oskam J, De Graaf JS, Klasen HJ. Fractures of the distal radius and scaphoid. J Hand Surg Br 1996; 21 (06) 772-774